HomeMy WebLinkAboutCOLEMAN Lots 6 & 7.D.
LO
GAAB-HD-1
GP~:ATER ANCHORAGE AREA BOROI~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
G/~L"~ N S. INSIDE LENGTH
NUMBER OF
COMPARTMENTS
INSIDE WIDTH
LIQUID
DEPTH __
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
_OUTSIDE DIAMETER
OR W DTH /¥
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
, LENGTH
, DEPTH
, BUILDING FOUNDATION
"~ "~ ~ SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION ~E
DISTANCE~'fl~ES TRENCH WIDIH
_y. LENGTH OF EACH LINE
TOTAL LENGTH
, OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
DISTANCE FROM
WELL: TYPE ~--'' 4'/-J, DEPTH BUILDING FOUNDATION.
NEAREST SEPTIC SEEPAGE
LOT LINE ~ SEWER LINE ~ , TANK ~' SYSTEM
DIAGRAM OF SYSTEM
DISTANCES:
WATER ~. I
'~' SAMPLE /~4~ , NEAREST
OTHER
~' , CESSPOOL ~' , SOURCES
DATE
APPROVED
GAAB-HD-2
GREATEI
327 Eagle St.
ANCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
9ROUGH
279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ~-"~/q/~ L..
'~)~,Z~,~:a~'.~)...~/ MAILING ADDRESS
LOCATION OF INSTALLATION
,OTHER
, SEEPAGE PIT ~ ,DRAIN FIELD
RESIDENCE ADDRESS
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
F~NANCED T.ROUG.
PERCOLATION TEST RESULTS
TO BE INSTALLED BY
ANnCmTED DATE OF C0MPLET~0N
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS
AS DESCRIBED BELOW.
Z~,,'P,,~'.Y~, PERMIT TO INSTALL A
SIZE OF UNIT TO BE SERVED
.TYPE SEEPAGE AREA
/,~,~ 7- I ,'~'--TYPE
DIAGRAM OF SYSTEM
llth Authority
I certify that I am familiar with the requirements of Greater An
above described system is in accordance with said code.
DATE //~'~.~/~ APPLICANTS SIGNATURE
Borough Ordinance No. 28-68 and that the